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"The problem is the lack of hope - the lack of a sense of possibility. People hate the health insurance system and they know things need to change. But people don't believe things can change."
- from Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program and associate professor at Harvard Medical School
What is the most critical domestic issue facing the next president? Many feel that it will be rebuilding our collapsing health insurance system.
And the prospects from the two leading candidates? What form might "JohnCare" or "BarackCare" take?
JohnCare: Basically, John McCain's plan would maintain the essential structure of our existing, largely for-profit, health insurance system. The plan would offer a refundable tax credit of $2,500 for an individual and $5,000 for a family to help purchase private health insurance. It would also provide a modest pool - $7 billion to $10 billion - to help people with health problems buy insurance.
Not clear is how these tax credits would be funded. Funding would possibly be achieved by placing caps on, or even getting rid of the tax-deductibility of employer-based insurance. This likely would eliminate the employer-based health insurance system that most people rely on today.
At this point, what is also unknown is whether McCain would extend the efforts of the Bush administration to privatize Medicare.
Critics of "JohnCare" maintain that the plan's proposed tax credits fall far short of significantly reducing the financial impact of purchasing private health insurance for many families, especially those with serious health problems. And by eliminating current employer-provided insurance, millions of those now insured would likely join the ranks of the uninsured.
BarackCare: Neither McCain's plan nor Barack Obama's plan embody strong activating principles of universal, affordable health insurance coverage. In the words of Dr. Woolhandler, quoted above, "... if we look at the actual health policy proposals of Obama and McCain, they are not good."
Obama's plan would also maintain the foundation of the present for-profit health insurance structure, although it would expand Medicaid and Medicaid-like programs. It would also establish a Medicare-type plan that employers and individuals could buy into.
BarackCare would increase regulation of the private market, prohibiting insurers from charging more to people with health conditions. Subsidies would be offered to low- and moderate-income families to aid in purchasing private insurance.
Critics of Obama's plan are clear in their views of its shortcomings. Concerning Medicaid expansion, the general feeling is that while short-term gains are experienced, long-term gains aren't encouraging. Critics also raise the issue of increased costs shunted to Medicare-like programs, resulting from the inevitable "cherry picking" by for-profit insurers operating under BarackCare.
From the actuarial standpoint, using lowest cost, high-deductible premiums to lure the potentially healthier people into your risk pool and telling others to go elsewhere makes the for-profit bottom line more assured. In the end, we all end up paying.
How can we locally expand our vision beyond the JohnCare and BarackCare scenarios?
A 2007 UCLA Center for Health Policy Research study determined that 2,000 children and 15,000 non-elderly adults living in Nevada County have no health insurance for all or part of the year. Since 2004, the Nevada County Chapter of Healthcare for All California (HCA) (www.healthcareforall.org) has been working locally to see if we cannot help correct this serious problem, here and statewide.
In September, our chapter hosts two important events, aimed directly at increasing local understanding of the current health insurance reform effort and to define what we can all do to contribute to this effort.
On Monday, Sept. 8, at Nevada City Hall, we are sponsoring a public town hall meeting. Doors will open at 7:30 p.m.; the event will be broadcast live on KVMR 89.5 FM from 8 to 10 p.m. It is free and suggested donations of $5 to $10 will go directly to the reform effort - we're all volunteers.
Discussion will center on our collapsing health insurance structure and possible solutions, including single payer health insurance proposed by state Sen. Sheila Kuehl. The panel will include local physicians, representatives from such groups as the California Nurses Association, Physicians for a National Health Program and business supporters. Call 274-0360.
On Saturday, Sept. 20, from noon to 6 p.m., we host a Silent Auction at Seaman's Lodge, Pioneer Park, Nevada City. Entertainment and free appetizers will be provided and guests will have the opportunity to bid on wine, food, and health services, as well as the creative art of well-known California artisans. Call 432-1299.
Terry Fieldhouse is a member of the Nevada County Chapter of Healthcare for All California.
- from Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program and associate professor at Harvard Medical School
What is the most critical domestic issue facing the next president? Many feel that it will be rebuilding our collapsing health insurance system.
And the prospects from the two leading candidates? What form might "JohnCare" or "BarackCare" take?
JohnCare: Basically, John McCain's plan would maintain the essential structure of our existing, largely for-profit, health insurance system. The plan would offer a refundable tax credit of $2,500 for an individual and $5,000 for a family to help purchase private health insurance. It would also provide a modest pool - $7 billion to $10 billion - to help people with health problems buy insurance.
Not clear is how these tax credits would be funded. Funding would possibly be achieved by placing caps on, or even getting rid of the tax-deductibility of employer-based insurance. This likely would eliminate the employer-based health insurance system that most people rely on today.
At this point, what is also unknown is whether McCain would extend the efforts of the Bush administration to privatize Medicare.
Critics of "JohnCare" maintain that the plan's proposed tax credits fall far short of significantly reducing the financial impact of purchasing private health insurance for many families, especially those with serious health problems. And by eliminating current employer-provided insurance, millions of those now insured would likely join the ranks of the uninsured.
BarackCare: Neither McCain's plan nor Barack Obama's plan embody strong activating principles of universal, affordable health insurance coverage. In the words of Dr. Woolhandler, quoted above, "... if we look at the actual health policy proposals of Obama and McCain, they are not good."
Obama's plan would also maintain the foundation of the present for-profit health insurance structure, although it would expand Medicaid and Medicaid-like programs. It would also establish a Medicare-type plan that employers and individuals could buy into.
BarackCare would increase regulation of the private market, prohibiting insurers from charging more to people with health conditions. Subsidies would be offered to low- and moderate-income families to aid in purchasing private insurance.
Critics of Obama's plan are clear in their views of its shortcomings. Concerning Medicaid expansion, the general feeling is that while short-term gains are experienced, long-term gains aren't encouraging. Critics also raise the issue of increased costs shunted to Medicare-like programs, resulting from the inevitable "cherry picking" by for-profit insurers operating under BarackCare.
From the actuarial standpoint, using lowest cost, high-deductible premiums to lure the potentially healthier people into your risk pool and telling others to go elsewhere makes the for-profit bottom line more assured. In the end, we all end up paying.
How can we locally expand our vision beyond the JohnCare and BarackCare scenarios?
A 2007 UCLA Center for Health Policy Research study determined that 2,000 children and 15,000 non-elderly adults living in Nevada County have no health insurance for all or part of the year. Since 2004, the Nevada County Chapter of Healthcare for All California (HCA) (www.healthcareforall.org) has been working locally to see if we cannot help correct this serious problem, here and statewide.
In September, our chapter hosts two important events, aimed directly at increasing local understanding of the current health insurance reform effort and to define what we can all do to contribute to this effort.
On Monday, Sept. 8, at Nevada City Hall, we are sponsoring a public town hall meeting. Doors will open at 7:30 p.m.; the event will be broadcast live on KVMR 89.5 FM from 8 to 10 p.m. It is free and suggested donations of $5 to $10 will go directly to the reform effort - we're all volunteers.
Discussion will center on our collapsing health insurance structure and possible solutions, including single payer health insurance proposed by state Sen. Sheila Kuehl. The panel will include local physicians, representatives from such groups as the California Nurses Association, Physicians for a National Health Program and business supporters. Call 274-0360.
On Saturday, Sept. 20, from noon to 6 p.m., we host a Silent Auction at Seaman's Lodge, Pioneer Park, Nevada City. Entertainment and free appetizers will be provided and guests will have the opportunity to bid on wine, food, and health services, as well as the creative art of well-known California artisans. Call 432-1299.
Terry Fieldhouse is a member of the Nevada County Chapter of Healthcare for All California.
